Workplace incivility, sometimes called bullying, is a secret kept on nursing units. How we treat each other is sometimes not very nice, even when it is done with the thought of patient safety and compassion. Sometimes, units have evolved to include incivility as part of their culture. Or, nursing across generations and a lack of understanding between generations can contribute to nursing incivility.
Incivility occurs in the nursing profession at many levels, leading to diminished trust in leadership, threats to the dignity of others, and decreased productivity (Luprell, 2007). It has a broad definition, including behaviors such as lack of respect, absence of honoring differences, rudeness, or unsociable speech, with the most drastic effects being violent behavior (Sprunk, LaSala, & Wilson, 2014).
Changing the Culture of a Unit
“When I interviewed for the nurse manager position in 2006, the leadership of the organization notified me that there were issues with high turnover, vacancies, and burnout. The staff members, despite their love of oncology nursing, were not feeling very satisfied; it showed in how they interacted with each other,” says ONS member Georgina Rodgers, RN, BSN, OCN®, NE-BC, director of clinical cancer services at the Taussig Cancer Institute at the Cleveland Clinic in Ohio.
Acknowledging that she’s always ready for a challenge, Rodgers accepted the position. With the help of her staff, colleagues, and leadership, she initiated changing the culture of nursing within her unit, from one of incivility, lack of trust, and tension to a high-functioning, collaborative culture where patients come first.
Early in her leadership, Rodgers says, “Customer service toward patients was phenomenal, but the interactions between coworkers and interdepartmentally was not always optimal. Coming into the area from an external facility, I really tried to immerse myself in their daily work to understand what was working well and what was potentially leading to their frustration. I observed and worked directly with employees, trying to get to know them. We took a long look at old nursing practices and tried to do away with those that were more ‘this is how we always did it’ and move toward ‘evidence shows that we should do this.’”
In working toward change, Rodgers says that she invited employee assistance counselors to staff meetings and provided education on communication, teamwork, and dealing with difficult patients. The staff also had an internal retreat during a staff meeting to work on interaction management.
“Time was our biggest constraint in changing the overall operations and culture,” she says. “This type of change does not occur overnight, and it was a slow but very worthwhile journey to evolve.”
In time, Rodgers says, staff began to notice change. “Patients and physicians felt like we began to run more efficiently and felt as though their nurses truly enjoyed the work they were doing. I am so proud of the team for taking ownership of issues that were important to them. Instead of complaining about what needed to change, and complaining about each other, I feel like they truly identified what mattered most to them and worked to improve the overall unit and even themselves individually. The work area has continued to grow and change, and while there are occasional glitches, the team has continued to function very well and always uphold compassion with their patients and each other.”
Rodgers says that she considered generational differences as she implemented changes. “Each generation [of nurses] is shaped by global events, family culture, parental influences, technology, and communication. A challenge occurs when all generations exist within one facility” (Lipscomb, 2010). The generations include Traditionalists (born 1900–1945), Baby Boomers (born 1946–1964), Generation X (born 1965–1980), and Generation Y/Millennials (born 1981–1999). Each generation has its own unique set of ideas of work satisfaction and accomplishment.
A Success Story of Collaboration and Teamwork
ONS member Deb Hillman, MSN, RN, OCN®, BMTCN™, is the bone marrow transplant clinical educator at Franciscan St. Francis Health in Indianapolis, IN. She conducted an informal focus group among her Millennial colleagues to understand why her unit was seemingly without workplace incivility and received some of the following responses.“Our culture is one of teamwork. We work as a team in all endeavors.”
- “Leadership does a thorough job making sure they get the right candidates to work on our bone marrow transplant/hematology unit. Every new hire interviews and is expected to shadow for at least part of the shift to meet the team.”
- “My preceptor told me that our badges say the same thing: RN. When she was my preceptor, she made me feel comfortable and equal.”
- “We can either foster this special culture or squash it. We foster collaboration and teamwork.”
- “A successful part of the culture is having all members of the team available when needed. We have physicians who are on the unit during day shift, as well as our dedicated NP, our PharmD, case manager and social worker. Having these available resources also helps with the culture of the unit. There is not a feeling of helplessness, but always a feeling of being able to get help when you need it.”
- “Ultimately, it is that we care about the patients first. Incivility in the workplace would have a negative effect on patient care and delivery.”
Hillman says she is proud of the culture on her unit. “Even though the nurses come from all four generations, they work well together and have the highest patient satisfaction scores in the hospital. This has been our bragging right for over 10 years. Our patients and families feel the camaraderie and spirit of teamwork on our unit.”
Key words emerge from Hillman’s survey, words that perhaps other units having difficulty with incivility can take to start or enhance their own culture change. These words are teamwork, trust, and above all, communication.